Ryan Hamilton

Questions 1 and 2 concern the following scenario:

1. Mrs M has been admitted to your medical admissions unit with confusion and also suffers from rheumatoid arthritis for which she is prescribed methotrexate 10 mg once weekly, folic acid 5mg once weekly, and paracetamol 1 g four times a day. She has no known drug allergies.

1.  The medical team diagnose Mrs M with a lower urinary tract infection and ask for your advice on the choice of treatment. Which of the following antibacterial agents would be the least appropriate to prescribe?
   
   
   
   1.  A  amoxicillin
      
   2.  B  cefalexin
      
   3.  C  co-amoxiclav
      
   4.  D  doxycycline
      
   5.  E  trimethoprim
   
   
2.  On discharge Mrs M has some questions about when to take her rheumatoid arthritis medicines. Which of the following counselling points would lead to suboptimal treatment?
   
   
   
   1.  A  Take methotrexate on the same day every week, and take folic acid the day before methotrexate.
      
   2.  B  Take methotrexate on the same day every week, and take folic acid on the same day as methotrexate.
      
   3.  C  Take methotrexate on the same day every week, and take folic acid the day after methotrexate.
      
   4.  D  Take methotrexate on the same day every week, and take the folic acid two days after methotrexate.
      
   5.  E  Take methotrexate on the same day every week, and take the folic acid on any day that is different to the methotrexate.
   
   
3.  Mr B is a patient on your ward who has been admitted with hyperglycaemia. Which of his medicines is most likely to cause the fluctuation in blood glucose levels?
   
   
   
   1.  A  aspirin
      
   2.  B  bendroflumethiazide
      
   3.  C  paracetamol
      
   4.  D  ramipril
      
   5.  E  tramadol
   
   
4.  With regard to continuing professional development records, which of the following is not true?
   
   
   
   1.  A  You can start at any point of the cycle.
      
   2.  B  At least one third must start at reflection.
      
   3.  C  Continuing professional development (CPD) records must be submitted online.
      
   4.  D  The General Pharmaceutical Council (GPhC) may request to see your portfolio of evidence.
      
   5.  E  Poor CPD records will not result in your removal from the register.
   
   

   Questions 5 and 6 concern the following scenario:

   
   
   
   
   1. Mrs D has been admitted to your gastroenterology ward with a peptic ulcer, which is currently being treated. She has a history of arthritis and myocardial infarction.
   
   
5.  Which one of her regular medicines is most likely to have caused the peptic ulcer?
   
   
   
   1.  A  clopidogrel 75 mg daily
      
   2.  B  naproxen 250 mg twice daily
      
   3.  C  propranolol 80 mg twice daily
      
   4.  D  ramipril 5 mg daily
      
   5.  E  simvastatin 40 mg daily
   
   
6.  The medical team wants to prescribe a proton pump inhibitor alongside her regular medication. Which of the following would be most appropriate?
   
   
   
   1.  A  esomeprazole
      
   2.  B  lansoprazole
      
   3.  C  omeprazole
      
   4.  D  any of the above
      
   5.  E  none of the above
   
   
7.  Mrs F comes to your pharmacy asking to speak to you. She has run out of her Microgynon pill. It is Friday night and she will not be able to obtain a prescription before Monday. You decide to give her an emergency supply after interviewing her. How many tablets do you give her?
   
   
   
   1.  A  3
      
   2.  B  5
      
   3.  C  7
      
   4.  D  14
      
   5.  E  21
   
   
8.  Miss P comes to your pharmacy complaining of nausea. On questioning, she tells you that she is four weeks pregnant. Which of the following would be the most appropriate course of action?
   
   
   
   1.  A  supply cyclizine
      
   2.  B  supply Gaviscon Advance
      
   3.  C  supply ginger tablets
      
   4.  D  supply Phenergan (promethazine)
      
   5.  E  none of the above
   
   
9.  Mrs S comes into your pharmacy complaining of a sore throat, which she has had for three days. While interviewing her about her sore throat you find out that she has had some Tunes, which only gave temporary relief. She would like you to suggest an over-the-counter (OTC) remedy for her. You ask her if she is on any other medication and she tells you that she takes carbimazole 5 mg daily and propranolol 10 mg three times daily, for hyperthyroidism. Which of the following is the most appropriate advice for this patient?
   
   
   
   1.  A  Gargle with dispersible aspirin.
      
   2.  B  Take paracetamol.
      
   3.  C  Take simple linctus.
      
   4.  D  Drink plenty of water as OTC products have insufficient clinical evidence.
      
   5.  E  Refer Mrs S to her GP.
   
   
10.  Mrs C asks you which medicine would be most appropriate for treating her 5-year-old son’s dry cough. What do you advise?
    
    
    
    1.  A  codeine linctus
       
    2.  B  dextromethorphan compound mixture
       
    3.  C  glycerin, honey, lemon and ipecacuanha linctus
       
    4.  D  pholcodine
       
    5.  E  simple linctus
    
    
11.  Mr Y is a night security guard and comes into your pharmacy for something to treat his hay fever. He is on no other medication and is otherwise healthy. Assuming that it is appropriate to sell him an antihistamine, which one would you not recommend?
    
    
    
    1.  A  acrivastine
       
    2.  B  cetirizine
       
    3.  C  chlorphenamine
       
    4.  D  loratadine
       
    5.  E  none of the above
    
    
12.  Mrs G is a chronic alcoholic who is being discharged from your ward. Before admission she was not taking any regular medicines. You decide to contact the discharging doctor as you have some concerns about the medicines she is being discharged on. Which drug is of most concern in alcoholic patients?
    
    
    
    1.  A  amoxicillin
       
    2.  B  cefalexin
       
    3.  C  ibuprofen
       
    4.  D  lactulose
       
    5.  E  thiamine
    
    
13.  Faizah is a 10-year-old patient on your paediatric surgical ward. The surgeons wish to prescribe a postoperative anti-inflammatory for her pain. Which one of the following drugs should not be prescribed for Faizah?
    
    
    
    1.  A  aspirin
       
    2.  B  diclofenac
       
    3.  C  ibuprofen
       
    4.  D  ketorolac
       
    5.  E  none of the above should be prescribed
    
    
14.  You have recently started working with another pharmacist but have some serious concerns about their behaviour and performance. You believe that patient care may be put at risk. Which of the following should you not do when initially raising your concerns?
    
    
    
    1.  A  keep a record
       
    2.  B  maintain confidentiality
       
    3.  C  report to your supervisor
       
    4.  D  report to the other pharmacist’s supervisor
       
    5.  E  report to the GPhC
    
    

    Questions 15 and 16 concern Mr E who has been admitted to the emergency department with suspected digoxin toxicity.

    
    
15.  Which of the following is not an effect of digoxin toxicity?
    
    
    
    1.  A  confusion
       
    2.  B  hallucination
       
    3.  C  insomnia
       
    4.  D  visual disturbances
       
    5.  E  vomiting
    
    
16.  You check the patient’s urea and electrolytes to establish why this may be happening. Which of the following electrolyte imbalances can precipitate digoxin toxicity?
    
    
    
    1.  A  hyperkalaemia
       
    2.  B  hypokalaemia
       
    3.  C  hypermagnesaemia
       
    4.  D  hypernatraemia
       
    5.  E  hyponatraemia
    
    

    Questions 17 and 18 concern Mrs R, a patient with rheumatoid arthritis.

    
    
17.  During your ward round Mrs R expresses concern about the side-effects of a new drug that she has been prescribed. She has recently been prescribed piroxicam. Which of the following is not a listed side-effect of this drug?
    
    
    
    1.  A  diarrhoea
       
    2.  B  nausea
       
    3.  C  renal failure
       
    4.  D  pupil dilation
       
    5.  E  bleeding
    
    
18.  The medical team diagnose Mrs R with mild depression as a result of her rheumatoid arthritis. The house officer asks you for some advice on what action to take. Assuming her rheumatoid arthritis is being appropriately treated, which of the following would be the best course of action?
    
    
    
    1.  A  Mrs R should be offered amitriptyline
       
    2.  B  Mrs R should be offered citalopram
       
    3.  C  Mrs R should be offered paroxetine
       
    4.  D  Mrs R should be offered cognitive behavioural therapy
       
    5.  E  none of the above
    
    
19.  Mrs K gives you a veterinary prescription. It is for Otomax (gentamicin compound) ear drops for her pet dog Parsnip, which has an ear infection. You find out that Otomax is licensed for the treatment of acute external otitis in dogs. Which of the following particulars does not legally need to be written on the prescription?
    
    
    
    1.  A  qualification of the prescriber
       
    2.  B  name/identification of the animal to be treated
       
    3.  C  species of the animal to be treated
       
    4.  D  name and address of the animal’s owner
       
    5.  E  statement that the drug was prescribed under the veterinary cascade
    
    
20.  An inspector from the GPhC has come to inspect your pharmacy premises. He asks to see your controlled drugs registers. You have a register with the last date of entry on 26th April 2014. On which date can you dispose of the register?
    
    
    
    1.  A  26th April 2015
       
    2.  B  26th April 2016
       
    3.  C  26th April 2017
       
    4.  D  26th April 2019
       
    5.  E  26th April 2024
    
    
21.  You are accuracy checking a prescription for Mrs B. Below is a label that your dispenser has prepared.

    

    
    

    Which cautionary label is missing?

    
    
    
    
    1.  A  Protect your skin from sunlight – even on a bright but cloudy day. Do not use sunbeds.
       
    2.  B  This medicine may colour your urine. This is harmless.
       
    3.  C  This medicine may make you sleepy. If this happens, do not drive or use tools or machines.
       
    4.  D  Do not take anything containing aspirin while taking this medicine.
       
    5.  E  Swallow this medicine whole. Do not chew or crush.
    
    
22.  You are working in a hospital manufacturing unit and are having a discussion with one of the technicians about sterilisation methods. Which of the following is not classed as a method of terminal sterilisation?
    
    
    
    1.  A  dry heat sterilisation
       
    2.  B  filtration sterilisation
       
    3.  C  gas sterilisation
       
    4.  D  ionising radiation sterilisation
       
    5.  E  steam sterilisation
    
    
23.  Continuing professional development occurs through various activities. Which of the following count towards CPD?
    
    
    
    1.  A  work shadowing
       
    2.  B  reading
       
    3.  C  learning by doing
       
    4.  D  staff training
       
    5.  E  all of the above
    
    
24.  Mrs Y comes to your pharmacy one afternoon asking for some advice. Her 7-year-old daughter has had two small episodes of diarrhoea that morning and would like something to treat it. Her daughter is otherwise well and there are no immediate warning signs. What is the most appropriate course of action?
    
    
    
    1.  A  supply loperamide
       
    2.  B  supply Pepto-Bismol
       
    3.  C  supply oral rehydration sachets
       
    4.  D  advise on increased fluid intake
       
    5.  E  none of the above
    
    
25.  Mr P comes to your pharmacy with a prescription for some temazepam tablets. You check the date on the prescription and do not dispense it as the prescription is invalid. For how long are prescriptions for temazepam valid?
    
    
    
    1.  A  4 weeks
       
    2.  B  8 weeks
       
    3.  C  12 weeks
       
    4.  D  20 weeks
       
    5.  E  24 weeks
    
    
26.  Mr A comes to your pharmacy with a prescription for some diazepam 5 mg tablets. You decide not to dispense the prescription as the dosing instructions are missing. Which of the following would not be acceptable on this prescription?
    
    
    
    1.  A  one as directed
       
    2.  B  one each night
       
    3.  C  one when required
       
    4.  D  once daily
       
    5.  E  none of the above
    
    
27.  Which schedules of controlled drugs do not allow repeats on an NHS prescription?
    
    
    
    1.  A  Schedule 2 and Schedule 3
       
    2.  B  Schedule 2 and Schedule 4
       
    3.  C  Schedule 3 and Schedule 4
       
    4.  D  Schedule 2 and Schedule 5
       
    5.  E  Schedule 3 and Schedule 5
    
    
28.  Mr D has been diagnosed with cellulitis and requires oral antibacterial therapy to treat it. The senior house officer asks for your advice on the ward round with regard to choice of the antibacterial. You check the patient’s notes and find out that the patient has a history of anaphylaxis with penicillin. Which of the following drugs would be most suitable?
    
    
    
    1.  A  cefalexin
       
    2.  B  clarithromycin
       
    3.  C  co-amoxiclav
       
    4.  D  flucloxacillin
       
    5.  E  meropenem
    
    

    Questions 29–32 concern Mr H, a 51-year-old Caucasian gentleman, who has just been diagnosed with hypertension.

    
    
29.  Which of the following would be the most appropriate first line treatment for Mr H’s hypertension?
    
    
    
    1.  A  bendroflumethiazide
       
    2.  B  candesartan
       
    3.  C  nifedipine
       
    4.  D  ramipril
       
    5.  E  verapamil
    
    
30.  Mr H’s GP decides he should be initiated on lisinopril 10 mg once daily. Which time of day would you advise Mr H to take his first dose of lisinopril?
    
    
    
    1.  A  in the morning before breakfast
       
    2.  B  in the morning with or after breakfast
       
    3.  C  in the evening
       
    4.  D  at night, before going to bed
       
    5.  E  none of the above
    
    
31.  While advising Mr H on when to take the lisinopril, he wants to know what the main side-effects of the drug are. Which of the following is a side-effect of lisinopril?
    
    
    
    1.  A  hyperthyroidism
       
    2.  B  persistent dry cough
       
    3.  C  sleep disturbance
       
    4.  D  taste disturbance
       
    5.  E  micro-deposits in the eye
    
    
32.  Mr H is also prescribed atorvastatin 10 mg tablets. The GP’s instruction is to ‘take one tablet once a day’. Mr H asks you when he should take the tablet, what do you advise?
    
    
    
    1.  A  take in the morning
       
    2.  B  take in the afternoon
       
    3.  C  take in the evening
       
    4.  D  any of the above
       
    5.  E  none of the above
    
    
33.  A man comes to your pharmacy complaining of diarrhoea, which started that morning. After interviewing him, you find out that he has just returned from a business trip to Laos. Which one of the following is the most appropriate course of action?
    
    
    
    1.  A  supply loperamide
       
    2.  B  supply Dioralyte
       
    3.  C  supply Pepto-Bismol
       
    4.  D  counsel on non-drug management
       
    5.  E  refer to GP
    
    
34.  A pharmacist’s role is to enable patients and the NHS to get the most from their medicines. Which of the following is not an aspect of Medicines Optimisation?
    
    
    
    1.  A  performing health checks
       
    2.  B  undertaking MURs
       
    3.  C  completing yellow card reports
       
    4.  D  reducing polypharmacy
       
    5.  E  improving inhaler technique
    
    

    Questions 35 and 36 are concerning Mrs F, a patient on your general medical ward who is currently taking furosemide 40 mg o.d.

    
    
35.  Mrs F is still showing signs of oedema and the medical team want to prescribe an additional diuretic. You decide to check Mrs F’s urea and electrolyte results, which are as follows:
    
    
    
    1.  sodium 137 mmol/L (normal range, 133–145 mmol/L)
       
    2.  potassium 3.1 mmol/L (3.5–5.3 mmol/L)
       
    3.  phosphate 0.84 mmol/L (0.8–1.4 mmol/L)
       
    4.  urea 3.4 mmol/L (2.5–6.5 mmol/L)
    
    

     Which one of the following drugs would you recommend to the doctor to add to her regimen?

    
    
    
    
    1.  A  amiloride
       
    2.  B  bendroflumethiazide
       
    3.  C  bumetanide
       
    4.  D  cyclopenthiazide
       
    5.  E  none of the above
    
    
36.  The following week Mrs F’s oedema has become worse but her electrolyte levels are in range. The medical team decide to increase the furosemide dose from 40 mg once a day to 40 mg twice a day. Mrs F says that she will take her first dose in the morning as usual, but is not sure when to take the second dose. What do you advise?
    
    
    
    1.  A  with her morning dose
       
    2.  B  at lunchtime
       
    3.  C  with her evening meal
       
    4.  D  at bedtime
       
    5.  E  the prescription is incorrect and needs to go back to the prescriber
    
    
37.  Mr A is a patient on your ward. Recently he has developed an acute exacerbation of gout. The medical team think that it may have been precipitated by one of his medicines. Below is a list of Mr A’s medication. Which one of his regular medicines do you think could have precipitated the gout?
    
    
    
    1.  A  allopurinol
       
    2.  B  atenolol
       
    3.  C  bendroflumethiazide
       
    4.  D  clopidogrel
       
    5.  E  enalapril
    
    
38.  With regard to controlled drug legislation, which of the following particulars does not need be recorded in the registers?
    
    
    
    1.  A  drug formulation
       
    2.  B  date supplied
       
    3.  C  quantity supplied
       
    4.  D  running balance
       
    5.  E  all of the above must be recorded
    
    
39.  You are a medicines information pharmacist for a hospital and have just received a query from one of the ward pharmacists. They have a patient on the ward who has brought in their own medicines from Spain. All the medicines have brand names but not the generic names. The ward pharmacist wants to know the generic names so that they can be prescribed on the drug chart. Which reference source would you initially use?
    
    
    
    1.  A  British National Formulary
       
    2.  B  Martindale: The Complete Drug Reference
       
    3.  C  Electronic Medicines Compendium
       
    4.  D  British Pharmacopoeia
       
    5.  E  European Pharmacopoeia
    
    
40.  Mr Y comes into your pharmacy with a veterinary prescription for his pet cat, Archimedes. The medicine is not licensed for use in cats and has duly been prescribed under the veterinary cascade. Which of the following particulars does not need to appear on the dispensing label?
    
    
    
    1.  A  address of the prescriber
       
    2.  B  name of the prescriber
       
    3.  C  name/identification of the animal
       
    4.  D  address of the animal’s owner
       
    5.  E  name of the animal’s owner
    
    
41.  Many drugs are stored in a refrigerator because of the increased stability this affords them. What is the recommended temperature range for such a refrigerator?
    
    
    
    1.  A  0–4°C
       
    2.  B  1–8°C
       
    3.  C  2–8°C
       
    4.  D  2–4°C
       
    5.  E  2–6°C
    
    
42.  You are on a post-take ward round with the medical team who are discussing Mr G, who currently takes Priadel (lithium carbonate) 400 mg daily and zopiclone 7.5mg at night when required. The medical team request lithium levels to confirm their diagnosis of suspected lithium toxicity. Which of the following is not a sign/symptom of lithium toxicity?
    
    
    
    1.  A  blurred vision
       
    2.  B  convulsions
       
    3.  C  depression
       
    4.  D  lack of coordination
       
    5.  E  muscle weakness
    
    

    Questions 43 and 44 regard Mr U who has recently been diagnosed with type II diabetes. He was unable to control his blood glucose levels solely with diet.

    
    
43.  Mr U’s GP would like to initiate an antihyperglycaemic drug. You confirm the patient’s history and find out that he is taking no other medication and that he has no other illnesses. Which drug would be most appropriate for this patient?
    
    
    
    1.  A  glibenclamide
       
    2.  B  gliclazide
       
    3.  C  insulin
       
    4.  D  metformin
       
    5.  E  rosiglitazone
    
    
44.  During your conversation with Mr U’s GP you discuss the side-effects and contraindications of each drug. Which of the following is not a side-effect of metformin?
    
    
    
    1.  A  anorexia
       
    2.  B  hypokalaemia
       
    3.  C  low vitamin B₁₂ levels
       
    4.  D  metallic taste
       
    5.  E  nausea
    
    
45.  A local GP wants to prescribe Viagra for one of his patients who has erectile dysfunction and also diabetes. He telephones you to confirm whether he can prescribe this for his patient and you agree that he can. You remind him to add a special endorsement next to the sildenafil on the prescription, otherwise you cannot dispense it. Which endorsement do you ask him to add?
    
    
    
    1.  A  Advisory Committee on Borderline Substances
       
    2.  B  Brand Name
       
    3.  C  British Approved Name
       
    4.  D  Original Pack
       
    5.  E  Selected List Scheme
    
    
46.  Mrs L is taking amitriptyline for her depression. While performing an MUR you decide to discuss the side-effects of amitriptyline. Which of the following is not a side-effect of this drug?
    
    
    
    1.  A  blurred vision
       
    2.  B  dry mouth
       
    3.  C  hypernatraemia
       
    4.  D  sedation
       
    5.  E  urinary retention
    
    
47.  You are dispensing morphine for Mr Z’s chronic pain and decide to offer him some counselling about side-effects. Which of the following is not a side-effect of morphine?
    
    
    
    1.  A  constipation
       
    2.  B  hypothyroidism
       
    3.  C  nausea
       
    4.  D  respiratory depression
       
    5.  E  sedation
    
    
48.  A senior house officer wishes to prescribe atenolol for one of your patients. You tell the doctor that the patient is diabetic and atenolol should be used with caution in this group of patients. What is the reason for this?
    
    
    
    1.  A  may affect the patient’s renal function
       
    2.  B  may mask the symptoms of hypoglycaemia
       
    3.  C  may affect the patient’s hepatic function
       
    4.  D  may elevate the patient’s blood glucose levels
       
    5.  E  may cause bronchospasm
    
    
49.  You are attending a ward round and notice that propranolol is prescribed for one of your asthma patients. You contact the prescriber and advise her to change the drug to another antihypertensive as propranolol is contraindicated in asthmatics. Which of the following is the correct explanation for the contraindication?
    
    
    
    1.  A  propranolol may cause bronchospasm
       
    2.  B  propranolol may cause bronchodilation
       
    3.  C  antiasthma drugs cause hypertension
       
    4.  D  propranolol interacts with all antiasthma drugs
       
    5.  E  none of the above
    
    
50.  Mr T comes to see you at your anticoagulant clinic. You check the patient’s INR and discover that it is higher than it should be. You read the patient’s recent notes and find out that it is caused by a drug that has been recently started. Which of the following drugs could cause an increase in the patient’s INR?
    
    
    
    1.  A  amiodarone
       
    2.  B  carbamazepine
       
    3.  C  phenobarbital
       
    4.  D  rifampicin
       
    5.  E  St John’s wort
    
    
51.  A customer comes to your pharmacy wanting to buy St John’s wort. You ask her if she is on any other medication and she tells you that she is also taking digoxin. You decide not to sell her the tablets as the two drugs interact. What is the mechanism of the interaction?
    
    
    
    1.  A  digoxin increases plasma levels of St John’s wort
       
    2.  B  St John’s wort causes bradycardia
       
    3.  C  St John’s wort decreases plasma levels of digoxin
       
    4.  D  digoxin inhibits the metabolism of St John’s wort
       
    5.  E  St John’s wort inhibits the metabolism of digoxin
    
    
52.  Miss Wood brings in a prescription for the following:
    
    
    
    1.  Dianette 1 daily
       
    2.  Sig 2 OP
    
    

     How many charges will you take from this patient?

    
    
    
    
    1.  A  none
       
    2.  B  one
       
    3.  C  two
       
    4.  D  three
       
    5.  E  four
    
    
53.  Mr L comes to your pharmacy complaining of a cold sore. After questioning him, you decide to sell him some Zovirax (aciclovir) topical cream. How often should he apply the cream?
    
    
    
    1.  A  once a day
       
    2.  B  twice a day
       
    3.  C  three times a day
       
    4.  D  four times a day
       
    5.  E  five times a day